ABSTRACT
Objetivo: Definir el concepto de microhemorragia cerebral y revisar las secuencias de resonancia magnética (RM) utilizadas para su valoración. Revisar cuáles son las patologías que presentan microhemorragias y que pueden beneficiarse del uso de secuencias de susceptibilidad magnética (SWI). Conclusión: Las SWI son útiles en la detección y caracterización de microhemorragias, venas y otras fuentes de susceptibilidad. La secuencia SWI mejora la sensibilidad diagnóstica con respecto a las secuencias convencionales potenciadas en T2* (eco de gradiente T2* [2D-GRE]). Las microhemorragias cerebrales pueden asociarse a diversas enfermedades, aparecer en contextos clínicos menos conocidos o servir como biomarcador tumoral en gliomas (ITTS) y como marcador de actividad inflamatoria en las placas de esclerosis múltiple (EM).(AU)
Objectives: Define the concept of cerebral microbleeds (CMB) and describe the most useful MRI sequences for detecting this finding. Review the entities that most frequently present with CMB and that may benefit from the use of susceptibility-weighted imaging (SWI) sequences. Conclusions: SWI is a useful MRI sequence for the detection and characterization of microhemorrhages, venous structures and other sources of susceptibility in imaging. SWI is particularly sensitive to local magnetic field inhomogeneities generated by certain substances and is superior to T2* GRE sequences for this assessment. CMB may be seen in different neurologic conditions, in certain infrequent clinical contexts and have a key role as a biomarker status in gliomas (ITTS) and as a marker of inflammatory activity in multiple sclerosis.(AU)
Subject(s)
Humans , Cerebral Intraventricular Hemorrhage/diagnostic imaging , Radiology , Magnetic Resonance SpectroscopyABSTRACT
OBJECTIVES: Define the concept of cerebral microbleeds (CMBs) and describe the most useful MRI sequences for detecting this finding. Review the entities that most frequently present with CMBs and that may benefit from the use of susceptibility-weighted imaging (SWI) sequences. CONCLUSIONS: SWI is a useful MRI sequence for the detection and characterization of microhemorrhages, venous structures and other sources of susceptibility in imaging. SWI is particularly sensitive to local magnetic field inhomogeneities generated by certain substances and is superior to T2* GRE sequences for this assessment. CMBs may be seen in different neurologic conditions, in certain infrequent clinical contexts and have a key role as a biomarker status in gliomas (ITTS) and as a marker of inflammatory activity in multiple sclerosis.
Subject(s)
Cerebral Hemorrhage , Magnetic Resonance Imaging , Humans , Cerebral Hemorrhage/diagnostic imaging , Magnetic Resonance Imaging/methodsABSTRACT
INTRODUCTION: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is the most common surgical treatment for Parkinson's disease (PD). Patient selection and genetic background can modify the response to this treatment. The objective of this study was to compare both clinical and pharmacologic response of STN-DBS between patients with monogenic forms of PD and non-mutation carriers with idiopathic PD. METHODS: A retrospective analysis among 23 carriers of genetic mutations (8 PRKN and 15 LRRK2) and 74 patients with idiopathic PD was performed. The study included comparisons of Unified Parkinson's Disease Rating Scale (UPDRS) II and III scores, Schwab and England (S&E) scale values, Hoehn & Yahr (H&Y) stage scores, and equivalent doses of levodopa before and after the surgery (at 6 and 12 months) between both groups. RESULTS: The mean age at the time in which STN-DBS was performed was 59.5 ± 8.6. Linear mixed models showed the absence of statistically significant differences between mutation and non-mutation carriers regarding levodopa doses (p = 0.576), UPDRS II (p = 0.956) and III (p = 0.512) scores, and S&E scale scores (0.758). The only difference between the two groups was observed with respect to H&Y stage in OFF medication/ON stimulation status being lower in genetic PD at 6 months after surgery (p = 0.030). CONCLUSION: Clinical and pharmacological benefit of bilateral STN-DBS is similar in PRKN and LRRK2 mutation carriers and patients with idiopathic PD.
Subject(s)
Deep Brain Stimulation , Parkinson Disease , Subthalamic Nucleus , Humans , Deep Brain Stimulation/methods , Leucine-Rich Repeat Serine-Threonine Protein Kinase-2/genetics , Levodopa/therapeutic use , Parkinson Disease/therapy , Parkinson Disease/surgery , Retrospective Studies , Subthalamic Nucleus/surgery , Treatment OutcomeABSTRACT
INTRODUCTION: White matter lesions are more prevalent in migraine patients than in the general population, especially those with a high frequency of attacks. A patent foramen ovale has been described as a possible link between migraine and white matter lesions. AIM: To determine the existence of a possible relationship between a patent foramen ovale and white matter lesions in a series of patients with chronic migraine. PATIENTS AND METHODS: Observational, single-centre, case-control study. Eighty-nine women with chronic migraine were selected. The persistence and characteristics of the patent foramen ovale were assessed by means of a transcranial Doppler study. The patent foramen ovale was classified as small, moderate or massive. Those detected at rest were considered permanent, and the others were classified as latent. The MRI protocol included T1-enhanced sagittal images, FLAIR-T2-enhanced axial images, and a proton density and T2-FSE combined sequence. The white matter lesions were classified as deep, periventricular or both. RESULTS: The prevalence of patent foramen ovale (53.6% versus 48.5%; p = 0.80) and the proportion of massive, permanent patent foramen ovale were similar among patients with and without white matter lesions. Neither was there any difference in the prevalence (55.6% versus 52.6%; p = 1.00) or the characteristics of the patent foramen ovale as a function of the distribution of white matter lesions. CONCLUSION: The results do not suggest that a patent foramen ovale intervenes in the pathophysiology of the white matter lesions observed in patients with migraine.
TITLE: ¿Existe relación entre las lesiones de la sustancia blanca asociadas a migraña y el foramen oval permeable? Análisis de una serie de pacientes con migraña crónica.Introducción. Las lesiones de la sustancia blanca son más prevalentes en los pacientes migrañosos que en la población general, especialmente en los que tienen una alta frecuencia de ataques. El foramen oval permeable se ha descrito como posible nexo de unión entre la migraña y las lesiones de la sustancia blanca. Objetivo. Determinar la existencia de una posible relación entre el foramen oval permeable y las lesiones de la sustancia blanca en una serie de pacientes con migraña crónica. Pacientes y métodos. Estudio observacional, unicéntrico, de casos y controles. Se seleccionó a 89 mujeres con migraña crónica. La persistencia y las características del foramen oval permeable se evaluaron mediante un estudio Doppler transcraneal. El foramen oval permeable se clasificó como pequeño, moderado o masivo. Se consideraron permanentes los detectados en reposo, y latentes, el resto. El protocolo de resonancia magnética incluyó imágenes sagitales potenciadas en T1, axiales potenciadas en FLAIR-T2 y secuencia combinada de densidad protónica y T2-FSE. Las lesiones de la sustancia blanca se clasificaron como profundas, periventriculares o ambas. Resultados. La prevalencia de foramen oval permeable (53,6% frente a 48,5%; p = 0,80) y la proporción de foramen oval permeable masivo y permanente fueron similares entre los pacientes con y sin lesiones de la sustancia blanca. Tampoco se encontraron diferencias en la prevalencia (55,6% frente a 52,6%; p = 1,00) o las características del foramen oval permeable en función de la distribución de las lesiones de la sustancia blanca. Conclusión. Los resultados no sugieren la intervención del foramen oval permeable en la fisiopatología de las lesiones de la sustancia blanca observadas en pacientes migrañosos.
Subject(s)
Foramen Ovale, Patent/complications , Leukoencephalopathies/complications , Migraine Disorders/complications , Adult , Case-Control Studies , Chronic Disease , Female , Humans , Middle AgedABSTRACT
Las técnicas de resonancia magnética cardiaca (RMC) actuales permiten el reconocimiento de múltiples variantes anatómicas cardiacas, como las hendiduras miocárdicas. Presentamos cuatro casos clínicos de hendiduras miocárdicas. Se trata de anomalías poco frecuentes y aparecen tanto en individuos sanos como en pacientes con diferentes afecciones cardiacas. Su etiopatogenia es desconocida, aunque se barajan varias hipótesis. Si bien la mayoría de las veces se trata de un hallazgo casual, es importante conocer su existencia porque pueden ser responsables de embolismos sistémicos (AU)
Current cardiac magnetic resonance imaging (cMRI) techniques enable many heart defects, like myocardial clefts, to be detected. We present four clinical cases of myocardial clefts. Myocardial clefts are uncommon abnormalities that are found in both healthy individuals and patients with different heart problems. The etiopathogenesis is unknown, although several hypotheses have been proposed. Although myocardial clefts are usually discovered incidentally, it is important to be aware of their existence because they can cause systemic embolisms (AU)
Subject(s)
Humans , Male , Female , Heart Defects, Congenital , Magnetic Resonance Imaging/methods , /instrumentation , /methods , Cardiomyopathy, Hypertrophic , /trends , Diagnosis, DifferentialABSTRACT
Current cardiac magnetic resonance imaging (cMRI) techniques enable many heart defects, like myocardial clefts, to be detected. We present four clinical cases of myocardial clefts. Myocardial clefts are uncommon abnormalities that are found in both healthy individuals and patients with different heart problems. The etiopathogenesis is unknown, although several hypotheses have been proposed. Although myocardial clefts are usually discovered incidentally, it is important to be aware of their existence because they can cause systemic embolisms.
Subject(s)
Heart Septal Defects/diagnosis , Magnetic Resonance Imaging , Humans , Incidental FindingsABSTRACT
Cluster headache is included in the group of trigeminal autonomic cephalalgias. Although the pathophysiology of cluster headache has not yet been sufficiently established, the theory of a central origin tells us that this headache is produced by hypothalamic dysfunction. More than 50 patients have been treated with deep brain stimulation of the posterior nucleus of the hypothalamus from 2001. The results show clinical improvement in more than 60% of the cases, opening a promising issue for the treatment of the cluster headache persistent after medical treatment. The surgical target that have been used until now is based on the origin of the cluster headache in the hypothalamic dysfunction. Nevertheless, It has still some open questions as the lack of proving the posterior nucleus of the hypothalamus is the real origin of the cluster headache, the lack of consensus about the anatomy of the surgical target and the variability of the structures stimulated with the surgery. The aim of this article is a review of the target used and propose another surgical target based on physiopathological concepts to explain the improvement with the deep brain stimulation in these patients.
Subject(s)
Cluster Headache/therapy , Deep Brain Stimulation/methods , Hypothalamus, Posterior/anatomy & histology , Hypothalamus, Posterior/surgery , Cluster Headache/physiopathology , Humans , Hypothalamus, Posterior/physiopathology , Trigeminal Autonomic Cephalalgias/physiopathology , Trigeminal Autonomic Cephalalgias/therapyABSTRACT
A pesar de que los cavernomas son malformaciones vasculares relativamente frecuentes en el sistema nervioso central, su localización intraventricular, especialmente en la región del foramen de Monro, es muy poco común. Esta localización atípica les confiere una serie de rasgos diferenciales, tanto clínicos como radiológicos, que pueden dificultar en extremo su diagnóstico preoperatorio y conducir a procedimientos ineficaces, como la radioterapia o el abordaje quirúrgico neuroendoscópico, e incluso peligrosos para el paciente, como la biopsia estereotáxica.Dado lo infrecuente de la patología y con el fin de ilustrar estas dificultades diagnósticas, se presenta a continuación un caso de cavernoma intraventricular de la región del foramen de Monro (AU)
Although cavernomas are relatively common vascular malformations in the central nervous system, they are rarely located in the ventricles and are even more rarely located in the region of the foramen of Monro. This atypical location results in a series of differential clinical and radiological characteristics that can make the diagnosis of these lesions extremely difficult and lead to inefficacious procedures like radiotherapy or a neuroendoscopic surgical approach or even to procedures that endanger the patient like stereotactic biopsy.We present a case of intraventricular cavernoma in the region of the foramen of Monro with the aim of illustrating the difficulties involved in the diagnosis of this rare lesion (AU)
Subject(s)
Humans , Male , Aged , Cerebral Ventricle Neoplasms/diagnosis , Hemangioma, Cavernous, Central Nervous System/diagnosis , Magnetic Resonance Spectroscopy , Stereotaxic TechniquesABSTRACT
Although cavernomas are relatively common vascular malformations in the central nervous system, they are rarely located in the ventricles and are even more rarely located in the region of the foramen of Monro. This atypical location results in a series of differential clinical and radiological characteristics that can make the diagnosis of these lesions extremely difficult and lead to inefficacious procedures like radiotherapy or a neuroendoscopic surgical approach or even to procedures that endanger the patient like stereotactic biopsy. We present a case of intraventricular cavernoma in the region of the foramen of Monro with the aim of illustrating the difficulties involved in the diagnosis of this rare lesion.
Subject(s)
Brain Neoplasms/diagnosis , Cerebral Ventricles , Hemangioma, Cavernous, Central Nervous System/diagnosis , Aged , Humans , MaleABSTRACT
Introducción. La agenesia unilateral de arteria carótida interna es una anomalía del desarrollo extremadamenterara (incidencia: 0,01%). Su diagnóstico generalmente es incidental durante la realización de una prueba radiológica.La mayoría de los casos descritos son sujetos adultos con síntomas de patología cerebrovascular. En este artículorevisamos la anatomía, el diagnóstico diferencial y las implicaciones clínicas de esta malformación, entre las que destacauna mayor prevalencia de aneurismas cerebrales. Casos clínicos. Presentamos dos casos de agenesia de arteria carótidainterna, uno en el lado derecho en una niña de 4 años, y otro en el lado izquierdo en una mujer de 58 años. Conclusiones.La tomografía computarizada de alta resolución para demostrar la ausencia de canal carotídeo en la base delcráneo y la angiorresonancia magnética son las pruebas radiológicas utilizadas para confirmar su diagnóstico. Aunquela mayoría de los casos permanecen asintomáticos, su detección es fundamental cuando se plantea una cirugía de la carótida,ya que la vascularización de ambos hemisferios cerebrales puede depender de la carótida ateromatosa que vamosa tratar(AU)
Introduction. Unilateral agenesis of the internal carotid artery is an extremely rare developmental anomaly(incidence: 0.01%). Diagnosis is often incidental in a radiological examination. Most of the cases described are in olderpatients with symptoms of cerebrovascular disorders. We review the anatomy, differential diagnosis and clinical implicationsof these malformations as the high prevalence of cerebral aneurysms. Case reports. We report the clinical and imagingfindings of two cases of agenesis of the internal carotid artery, one on the right in a 4 years old female, and another onthe left, in a 58 years old woman. Conclusions. High resolution CT to demonstrate the absence of the carotid canal atthe skull base and angio-MR are the radiological proves used to confirm the diagnosis. Although many of these casesremain asymptomatic, their recognition has important implications, specially when we are planning carotid endarterectomy,because both cerebral hemispheres may be dependent upon the atheromatous carotid(AU)
Subject(s)
Humans , Female , Child, Preschool , Middle Aged , Carotid Artery, Internal/abnormalities , Cardiovascular Abnormalities/diagnosis , Magnetic Resonance Imaging/methods , Circle of Willis/abnormalities , Tomography, X-Ray Computed/methods , Cerebral Angiography/methodsABSTRACT
INTRODUCTION: The advent of computed tomography (CT) has allowed the early detection of pathological changes in patients with cystic fibrosis (CF). Description of the early pathological changes and distribution of bronchiectasis in children with CF is limited, because most studies have been performed in older children and adults with well-established lung disease. The aim of this study was to describe the distribution pattern of this disease in Asturius. MATERIAL AND METHOD: We performed a retrospective study of the medical records and CT scans of patients followed up in our Cystic Fibrosis Unit. CT scans were scored by two radiologists according to Bhalla and Nathanson scores. Pathological changes were analyzed and correlated with clinical data and pulmonary function tests. RESULTS: The 41 CT reviewed contained between 10 and 47 slices, with a median of 16. The total number of slices was 758, of which 606 (79.95%) were considered acceptable and 152 were considered unacceptable by the radiologists. The most frequent lesions found were bronchiectasis (78.38%), followed by mucous plugs (37.84%). The most frequently affected bronchopulmonary segments were S1 and S2 in the right lung. Statistically significant correlations were found between Bhalla and Nathanson scores and disease duration. No statistically significant correlations were found between Bhalla and Nathanson scores and pulmonary function tests. CONCLUSIONS: The most frequent lesions in our environment were bronchiectasis followed by mucous plugs. The upper right lobe was the first to be affected, which correlates with findings in most published studies.
Subject(s)
Cystic Fibrosis/diagnostic imaging , Adolescent , Bronchiectasis/diagnostic imaging , Child , Child, Preschool , Cystic Fibrosis/physiopathology , Female , Humans , Infant , Male , Respiratory Function Tests , Retrospective Studies , Spain , Tomography, X-Ray ComputedABSTRACT
Introducción: La aparición de la tomografía computarizada (TC) ha permitido la detección precoz de cambios patológicos en los pacientes con fibrosis quística. Hay poca descripción de los cambios patológicos iniciales y de la distribución de las bronquiectasias en niños pequeños con fibrosis quística, ya que la mayoría de los estudios se centran en grupos de niños mayores y adultos, con la enfermedad pulmonar bien desarrollada. El objetivo fundamental de nuestro estudio es describir el patrón de distribución de la enfermedad en Asturias. Material y método Se realizó un estudio retrospectivo de las historias clínicas y las TC de pacientes pediátricos seguidos en nuestra Unidad de Fibrosis Quística. Las TC fueron evaluadas por dos radiólogos según las escalas de Bhalla y Nathanson, y se realizó un análisis de los hallazgos patológicos, correlacionándolos con datos clínicos y espirometrías. Resultados: Las 41 TC realizadas constaban de entre 10 y 47 cortes, con una mediana de 16. El total de cortes realizados fue de 758, de los que los radiólogos consideraron que 606 (79,95 %) eran valorables, y 152 (20,05 %), no. Las lesiones halladas con más frecuencia fueron bronquiectasias (78,38 %), seguidas de tapones de moco (37,84 %). Los segmentos broncopulmonares afectados predominantemente fueron el S1 y S2 derechos. Se encontraron correlaciones estadísticamente significativas entre las escalas de Bhalla y Nathanson y el tiempo de evolución de la enfermedad. No se encontraron correlaciones estadísticamente significativas entre las escalas de Bhalla y Nathanson y las pruebas de función pulmonar. Conclusiones: Las lesiones predominantes fueron bronquiectasias y tapones de moco. El lóbulo superior derecho ha sido el primero en afectarse evolutivamente, lo que coincide con la mayoría de la literatura médica
Introduction: The advent of computed tomography (CT) has allowed the early detection of pathological changes in patients with cystic fibrosis (CF). Description of the early pathological changes and distribution of bronchiectasis in children with CF is limited, because most studies have been performed in older children and adults with well-established lung disease. The aim of this study was to describe the distribution pattern of this disease in Asturius. Material and method We performed a retrospective study of the medical records and CT scans of patients followed up in our Cystic Fibrosis Unit. CT scans were scored by two radiologists according to Bhalla and Nathanson scores. Pathological changes were analyzed and correlated with clinical data and pulmonary function tests. Results: The 41 CT reviewed contained between 10 and 47 slices, with a median of 16. The total number of slices was 758, of which 606 (79.95 %) were considered acceptable and 152 were considered unacceptable by the radiologists. The most frequent lesions found were bronchiectasis (78.38%), followed by mucous plugs (37.84 %). The most frequently affected bronchopulmonary segments were S1 and S2 in the right lung. Statistically significant correlations were found between Bhalla and Nathanson scores and disease duration. No statistically significant correlations were found between Bhalla and Nathanson scores and pulmonary function tests. Conclusions: The most frequent lesions in our environment were bronchiectasis followed by mucous plugs. The upper right lobe was the first to be affected, which correlates with findings in most published studies
